Public versus private investment in determining child health outcomes : evidence from India

This article examines the relationship among access to drinking water, sanitation facilities and health outcomes for children in India. We use the NFHS 2005-2006 household-level survey data to construct the nutritional distribution for two anthropometric health measures for children between ages 6 months and 2 years: the weight-for-height ('wasting') and height-for-age ('stunting') z-scores. Using a quantile regressions approach, we find that public goods such as piped water are not associated with improving child health outcomes. On the other hand, private investments within the home such as pit latrines and flush toilets do have a strong influence on health outcomes, with the magnitude of the effects being the largest in the middle of the respective nutritional distributions. Further, rural children at the lower end of the nutritional distribution benefit much more than their urban counterparts. Also, the educational attainment of the mother has a strong association with better health outcomes, both in the short run as well as in the long run. Overall, our results provide evidence against 'one-size-fits-all' policies, and point towards incentives for private investments in sanitation and mother's education, especially in rural areas and for children in the middle of the conditional nutritional distribution.